IP Annals of Prosthodontics and Restorative Dentistry 2020;6(2):110–113

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IP Annals of Prosthodontics and Restorative Dentistry

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Case Report

Removable denture options in rehabilitation of missing dentition: A series of casereports

Annesha Koinyaki Konwar1, Devi Parameswari1,*, H Annapoorni1

1Dept. of Prosthodontics, Meenakshi Ammal Dental College and Hospital. Maduravoyal, Chennai, Tamil Nadu, India

A R T I C L E I N F O

Article history:Received 05-05-2020Accepted 11-05-2020Available online 11-06-2020

Keywords:Proprioception of implantsOsseointegrationOsseoperception

A B S T R A C T

Even though fixed dental prosthesis and dental implants are now in growing trend, conventional RPDsare still prevalent and considered the gold standard technique. Conventional RPDs along with their variousmodifications are comparatively less invasive, cost-effective and best treatment option for partial edentulismin cases where fixed prosthesis and implants are contraindicated. Such prosthesis aims in rehabilitation withadequate stability, retention and support similar to a fixed dental prosthesis and also better aesthetics withmaintaining hygiene like that of a removable prosthesis

© 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license(https://creativecommons.org/licenses/by-nc/4.0/)

1. Introduction

Prosthetic dentistry aims in replacement of missing teethand the contiguous tissues while maintaining proper oralfunctions, patients’ comfort and health and aesthetics withany artificial substitutes.1 Prosthetic options for replace-ment of partially missing dentition include removablepartial denture (RPD), fixed dental prosthesis (FDP),and implant‑retained prosthesis. However, FPDsor implants are opted out as treatment option in patientshaving excessive resorption of residual ridge followingextraction and also with jaw defects following traumaor any surgery. Prosthetic rehabilitation of such casesare best carried out with conventional RPD prosthesis orfixed removable prosthesis, thus restoring the defectiveareas of hard and soft tissues inorder to achieve properoral function, speech and aesthetics. Such prosthesis aimsin rehabilitation with adequate stability, retention andsupport similar to that of a fixed dental prosthesis andbetter aesthetics with maintaining hygiene like that ofa removable prosthesis.2 Recently, implants have gainedattention over removable prosthesis as a treatment option,yet various anatomical, physiological, psychological factors

* Corresponding author.E-mail address: drdeviparameswari@gmail.com (D. Parameswari).

of the patients make it a contradiction. Also these are notcost effective. Conventional RPDs alongwith their variousmodifications are the most cost‑effective, non-invasive and comparatively better option for rehabilitationof partial edentulism. This article presents a series ofcase reports of rehabilitation of partial edentulism withconventional RPDs with modifications.

2. Case 1: Rehabilitation with tooth supportedoverdenture

Overdenture has always been a better treatment option ascompared to a conventional RPD prosthesis. Among allpractical measures used in preventive dentistry, overdentureis one of the best option which delays the process ofresorption, unlike a complete denture, improves denturefoundation area and increases masticatory efficiency.3

3. Case Report

A 56-year-old male patient reported to the Department ofProsthodontics to get his missing teeth replaced. He hadpartially edentulous maxillary and mandibular arches. 13and 24 were present in the upper arch [Figure 1 a]. Hewas not happy with the retention of his previous maxillary

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removable prosthesis and wanted a new retentive prosthesis.

3.1. Treatment procedure

After assessing the inter-arch space with a tentative jawrelation of the diagnostic casts, an overdenture with longcopings was suggested to the patient. For the mandibulararch, he opted for a conventional RPD. After intentionalroot canal of 13 and 24, teeth preparation were done andimpressions made [Figure 1b]. The copings obtained werechecked for fit in the patients’ mouth and finally cementedwith glass ionomer cement [Figure 1c]. The thickness of thecopings were not more than 1 mm. Border molding of themaxillary arch was done with green stick compound. Finalimpression was made with light body elastomer material(Zhermack Zetaplus) [Figure 1d] and master casts werepoured with Type IV gypsum. Occlusal rims were madeand maxilla-mandibular relations recorded intraorally. Teethsetting was evaluated in the patient’s mouth for phonetics,vertical and centric relation and aesthetics [Figure 1e].The final denture was fabricated using DPI heat-cure pinkacrylic resin [Figure 1f]. Insertion of the completed dentureswere done and the patient showed satisfactory results withretention, phonetics and aesthetics [Figure 1g].

4. Case 2: Rehabilitation using precision attachmentfixed removable prosthesis

Precision attachments are cost effective option for treatmentas they provide better vertical support and stimulation tothe underlying tissues through periodic vertical massage ascompared to a conventional RPDs. They have with adequateretention and stability similar to a fixed dental prosthesis.These also help in splinting the teeth and provide favourablebiomechanics.

5. Case Report

A 46 year‑old female patient reported to theDepartment of Prosthodontics for prosthetic rehabilitationof her missing teeth in the mandibular right posterior region.On examination, she revealed missing lower right secondpremolar, both first and second molars and left secondpremolar [Figure 2 a]. She had missing left second premolar[Figure 2b] in her maxillary arch. She had a history ofwearing lower removable partial denture but had a problemwith retention. Considering the financial constraints, aprecision attachment fixed RPD was planned for the rightlower missing teeth together while replacing the left secondpremolar. A conventional RPD replacing the missing secondpremolar was planned for the maxilla.

5.1. Treatment procedure

Primary maxillary and mandibular impressions were madeusing irreversible hydrocolloid and casts were poured.

Fig. 1: a: Pre-op maxilla and mandible, b: Tooth preparation of13,24, c: Cementation of metal copings, d: Final impression ofmaxilla, e: Wax trial in the patient, f: Completed maxillary andmandibular dentures, g: Maxillary overdenture with mandibularRPD insertion

Jaw relation was recorded and casts were articulatedusing facebow. These articulated casts were evaluated forinterarch space and occlusion. Abutment tooth preparationswere done on lower right canine and first premolaralongwith left first molar for fabrication of porcelain fusedto metal restoration [Figure 2c]. A two-stage putty-lightbody impression was made of the lower arch and pouredin die stone. Ball attachment was attached to a custom Ni-Cr bar in the region of first premolar. After investing andcasting, intraoral framework try-in was done for proper fitand assessment of interarch space [Figure 2d]. The PFMcrowns were cemented on the right canine and first premolarwith glass ionomer cement. Similarly the PFM crown wascemented on the left first molar. Rest seats were prepared onthe left first premolar and the first molar [Figure 2e]. A pickup impression was made with putty-light body polyvinylsiloxane material. Wax up of the lingual bar framework wasdone on the master cast and the final framework was cast

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in Co-Cr alloy. Due to very limited space for replacing theleft second premolar, acrylic resin was extended from thelingual bar joining the precision attachment to close thespace. [Figure 2f,g].

Fig. 2: a: Pre-op mandible with missing 45,46,47, b: Pre-opmaxilla with missing 25, c: Tooth preparation done in 43,44, Fig2d: PFM crowns with custom bar and ball attachment, e: PFMcrowns cemented on 43,44, f: Framework insertion in andibulararch with attachment and rests on 34,36, g: Post-op view

6. Case 3: Rehabilitation with a cast partial removableprosthesis

Removable cast partial prosthesis are considered betterretentive as compared to conventional removal partialdentures. Moreover in a distal extension case, masticatoryefficiency and retention with conventional prosthesis aregreatly affected as a result of rotational movement aroundthe fulcrum line. Cast partial dentures with adequate rests,tooth and tissue coverage can be a better option in suchcases.

7. Case Report

A 67 year old male patient reported with missing upperteeth. He was extremely unhappy with his existing upper

RPD as it was not retentive and had chewing difficulties.Intraoral examination showed Kennedy’s Class II situationwith missing left canine, premolars and molars [Figure 3 a].He was presented with all possible treatment modalities forprosthetic rehabilitation. He did not want implant-supportedrestorations considering his financial condition. He optedfor cast partial denture and with his consent, the treatmentwas started.

7.1. Treatment procedure

Upper and lower diagnostic impressions were made withirreversible hydrocolloid and casts were poured. Surveyingof diagnostic casts were done using a dental cast surveyor inwhich path of insertion and removal, possible interferencesand guiding planes were assessed.4–6 Anteroposteriorpalatal strap was planned as major connector andcircumferential clasps with distal rest was planned on 16and with mesial rest was planned on 17. On 22, I bar claspwas planned [Figure 3b]. Required mouth preparations weredone in the patient’s mouth and final impressions were madewith putty and light body impression material. The castswere poured with die stone. The master cast was surveyedwhile blocking the unfavourable undercuts and refractorycasts were made. This was followed by contouring of waxpattern. Casting and investment followed by finishing andpolishing were done in a conventional manner. The metalframework was tried in the patients’ mouth for accurateadaptation [Figure 3c]. Occlusal rim was made and teethsetting was checked intraorally [Figure 3d]. Once curingwas done in the conventional way, and the final prosthesiswas inserted, the patient showed extreme satisfaction withboth fit and aesthetics [Figure 3e,f]. After 1 month follow-up, the patient showed extreme satisfaction with retentionand masticatory efficiency.

8. Discussion

The concept of conventional tooth-retained overdenturesis a simple and cost effective treatment than the implantoverdentures. When few teeth with good prognosis arepresent in an otherwise compromised dentition, they can beretained and used as abutments for overdenture fabrication,thus helping greatly in improving the retention and stabilityof the final prosthesis. The success of a tooth-supportedoverdenture treatment depends upon proper selection ofcase and attachments. Various factors for attachmentselection like available buccolingual and inter arch space,amount of bone support, opposing dentition, clinicalexperience, personal preferences, maintenance problems,cost and patient’s motivation should be considered.7

A precision attachment prosthesis has advantages ofbetter retention and stability similar to a fixed prosthesisand also better aesthetics and hygiene maintenance similarto conventional removable prosthesis. It further splints the

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Fig. 3: a: Pre-op maxillaryocclusal view, b: Metal framework onmaster cast, c: Framework trial in patient, d: Inter-occlusal record,e: Post-op right lateral view, f: Post-op left lateral view

abutment teeth thus providing favourable biomechanics.Only disadvantage being periodic replacement of theclip due to wear of the retention clip as a result ofrepeated removal and placement of prosthesis. 2 Persic etal. evaluated the effects of various treatment options onaesthetics, chewing efficiency and oral health and stated thatprecision attachment‑retained RPD showed bettertreatment options as compared to clasp‑retainedRPD.8

Most denture wearers are unable to perform satisfactorymasticatory functions due to lack of retention of theconventional removable prosthesis. Also in a long distalextension edentulous case, giving a conventional RPD orprecision attachment denture do not give satisfactory results.In such cases, cast partial denture is the key for a betterretentive prosthesis. Primary retention for such dentures canbe achieved by placing retaining elements on the selectedabutment teeth, while secondary retention can be achievedthrough the intimate contact of the underlying tissues withthe denture bases and the major connector. Moreover castcircumferential clasps offer greater stability because it hasa rigid shoulder.9 Also cast partial dentures are a bettermeans as compared to conventional dentures in aiding tastesensation of patients due to the ability of transmission ofheat.

9. Conclusion

Although fixed dental prosthesis and dental implants arein trend, conventional RPDs are still prevalent and betteropted. The aim should be not only towards restoringoral functions and speech, but also on restoring aestheticswhich proper planning and selection of patients. Patientexpectations should be taken into consideration beforeany treatment procedure. Conventional RPDs with specificmodifications are yet considered best and gold standardtreatment for any partially edentulous individual.

10. Source of Funding

None.

11. Conflict of Interest

None.

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Elsevier Mosby; 2011. p. 1.2. Munot V, Nayakar R, Patil R. Prosthetic rehabilitation of mandibular

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4. Cowan RD, Gilbert JA, Elledge DA, McGlynn FD. Patient use ofremovable partial dentures: Two- and four-year telephone interviews.J Prosthet Dent. 1991;65(5):668–70.

5. Agerberg G, Carlsson GE. Chewing Ability in Relation to Dental andGeneral Health. Acta Odontol Scand. 1981;39(3):147–53.

6. Kapur KK, Deupree R, Dent RJ, Hasse AL. A randomized clinical trialof two basic removable partial denture designs. Part I: Comparisonsof five-year success rates and periodontal health. J Prosthet Dent.1994;72(3):268–82.

7. Samra R, Bhide S, Goyal C, Kaur T. Tooth supported overdenture:A concept overshadowed but not yet forgotten! J Oral Res Rev .2015;7(1):16–21.

8. Persic S, Kranjcic J, Pavicic DK, Mikic VL, Celebic A. Treatmentoutcomes based on patients’ self‑reported measures afterreceiving new clasp or precision attachment‑retained removablepartial dentures. J Prosthodont. 2015;24:1–8.

9. Suwal P, Singh R, Ayer A, Roy D, Roy R. Cast Partial Dentureversus Acrylic Partial Denture for Replacement of Missing Teeth inPartially Edentulous Patients. J of Dent Materials and Techniques.2017;6(1):27–34.

Author biography

Annesha Koinyaki Konwar Post Graduate Student

Devi Parameswari Associate Professor

H Annapoorni Professor and HOD

Cite this article: Konwar AK, Parameswari D, Annapoorni H.Removable denture options in rehabilitation of missing dentition: Aseries of case reports. IP Ann Prosthodont Restor Dent2020;6(2):110-113.